Different question on deviated septum

[John Reinertson]

The statement that there is no surgery to correct a malfunctioning eustachian tube is correct.
The use of decongestants (Sudafed) and nasal steroids (nasonex or Nasacort Aq or flonase or any of several others) have been very helpful for a large number of my patients, both diving and non-diving.

The Eustachian tube is not just a bony canal. It is lined with mucus-secreting membranes and has muscles that control its opening at the pharyngeal end.

If the bony canal is severely deformed or traumatized, it would indeed be difficult to get it working again.

In my experience, it is far more likely for the dysfunction to be caused by inflammation, most commonly from allergies (allergic rhinitis) or from nonallergic rhinitis, or from infections viral or otherwise.

This inflammation and the swelling that goes with it can cause
difficulty equalizing, but can be alleviated with nasal steroid sprays or decongestants.

I cannot advise you as an individual, because I haven't examined you and don't know all your medical history, but I would certainly ask your family doctor to let you try nasal steroids and sudafed for 1 or 2 weeks, then try equalizing.

You may be pleasantly surprised at how easy it can be after getting the inflammation cleared.

If you have any chronic nasal stuffiness or difficulty breathing thru your nose, you may have allergies and could possibly benefit from talking to an allergist.

ENT surgeons are part of the process of solving the puzzle, but not always the last step. Keep looking.

John

 

[kas]

Thank you for your remarks, Dr. Reinertson.

I should respond to a couple of your remarks, as I may have been unclear in my previous message. I don't have chronic stuffiness. My difficulty with nasal breathing occurs only when one side of my nose is obstructed with a cold (1-2x/year).

Perhaps the allergist is a good idea. Can they work with such obscure symptoms as "difficulty equilizing?

Are there further tests that might confirm any of the following?
* allergic rhinitis
* sinus disease
* adnenoidal disease
* posterior nasal polyps

My primary care family practicioner did recommend Sudafed, but he was unfamiliar with diving issues and treatments. I'll mention the nasal steroids to him. For typical patients, does the effect of a nasal spray steroid last for several hours, e.g., during a dive? Is there a medical resource that I should mention to my family practioner, that might help him to be more comfortable in prescribing a nasal steroid?

Do the nasal steroids take effect immediately, such that I could, in one pool dive, compare with and without the spray?

Sounds like the ENT may have given me a bit of an early instruction to terminate.

Your remarks and general guidance may yet salvage for me years of pleasure diving--I am already in your debt. I am not yet resigning this possibility.

Keith

 

[The Iceni]

I hope you don't mind me butting in from the back of the class again!

kas once bubbled...
Perhaps the allergist is a good idea.

. . .For typical patients, does the effect of a nasal spray steroid last for several hours, e.g., during a dive? Is there a medical resource that I should mention to my family practioner, that might help him to be more comfortable in prescribing a nasal steroid?

Do the nasal steroids take effect immediately, such that I could, in one pool dive, compare with and without the spray?

Keith

Hi again, Keith,

I think your ENT man has already excluded sinus disease, adenoidal disease and nasal polyps. This leaves us with chronic rhinitis, whether allergic in origin or not. As John R has described you can do very little about your bony anatomy but we can do a great deal about the inflammation of your mucous membranes.

This very much like the management of asthma. There are "treaters" and there are "preventers". It may help if you think of decongestants such as sudafed and xylometazolone as treaters since they reduce the inflammation in the short term (by a reduction in localised blood flow) and can be taken just prior to diving.

Steroids are "preventers". They act by reducing the sensitivity of the membranes to whatever it is that is causing the inflammation. In consequence they do not act at once. Indeed it may take several days for the effects of a nasal steroid to become apparent and indeed to wear off.

I am not familiar with allergists in the US but here their remit is to identify the cause of the problem, such as specific pollens (including oil seed rape) and house dust mite in asthma and allergic rhinitis. Sadly there is often very little that the patient can often do to completely avoid the identified allergen, which returns us to inhaled steroid preventers and those treaters, which are very widely and safely used.

I agree it does sound like the ENT specialist may have given you a bit of an early instruction to terminate, but do be advised by you own doctors.

 

[wvrotorhead]

Please forgive my butting in here folks, but if a medical/surgical solution to KAS' problem is not possible, how about a technological one? I recall seeing a mask, the Proear 2000, (http://www.proear2000.com/) that has rigid aviation headset style "ear domes" that are connected via flexible tubing to the mask itself. Therefore, when equalizing the mask, the ears themselves are equalized as well.
Please don't think I'm trying to argue any point the docs are making, but I just thought it might be something worth checking into. It might at the very least be a last-ditch attempt to salvage a diving future. Let me know if it works out.
Billy

 

[kas]

Thank you for your recommendation. I too want to save my diving future!

I've seen the mask and it is not so rugged as what we might hope for.

If I were to lose the mask at depth, I would probably have problems equilizing on ascent. I don't mind carrying a backup, but this does seem like a risk to me. Equilizing during ascent is normally (but I'm abnormal) hands-free, automatic. and easy?

If the mask was knocked off, by my logic I would not be subject to sudden lethal onrush of pressure, as I would be equilized as appropriate for that depth.

I read a review by a woman who claimed that it allowed her to dive when previously this was impossible.

Any other input?

Keith

 

[The Iceni]

wvrotorhead once bubbled...
. . . how about a technological one? I recall seeing a mask, the Proear 2000, . . Therefore, when equalizing the mask, the ears themselves are equalized as well.
Please don't think I'm trying to argue any point the docs are making, but I just thought it might be something worth checking into. It might at the very least be a last-ditch attempt to salvage a diving future. Let me know if it works out.
Billy

Hi Billy,

An exccellent suggestion but this device does not work by "equalizing the mask, the ears themselves are equalized as well" since it is the air within the middle ear that needs to be equalised and the mask cannot provide a direct communication between the middle ear and ambient pressure.

It cannot bypass the eustachian tube. That is anatomically impossible!

For further discussion may I suggest you take a look at

http://www.scubaboard.com/showthread.php?s=&threadid=12136

If the testimonials provided by the manufacturers are genuine it must work by some other means but it may be worth a try to save a diving career.